The Liver Disease 30% of Us Have and Never Feel | Prof Aleksander Krag

Simon Hill (0:04)

You've said before that when you think about liver disease, you don't necessarily think about the statistics, you think about a patient called Henry. Who is Henry and why is this fictional character important to the way that you think about your work?

Aleksander Krag (0:20)

Henry is the key for me, the driver for me why I do research, why I love to be a clinician, but also know we know research.

Henry is a patient that made a big impression on me. Because Henry had what we today call steatotic liver disease, it's a disease with too much fat in the liver. He's been living that for a long time. We've basically missed it. He's been under our nose all the time.

Then Henry emerges later the health care system with advanced stage liver disease. Sadly, I couldn't save him. He was too sick or he had a cancer, he could not have a liver transplant, we also have other manifestations of chronic liver disease. What is my vision here as a researcher and as a clinician? I want to change the faith of people like Henry because Henry was over 50 He had been sick for over 55, he had been sick for 15, 20 years in his liver. I want to see a future where we find Henry 10, 15 years earlier. He identified the causes, we implement the treatments, we come with the changes in his lifestyle that can change his life so he had kids, he had a lovely family. It's very sad to say goodbye to him when he could have lived longer, happier, maybe 20, 30, just like anybody else. That's why in my mind at the back of the head, I have Henry.

Simon Hill (1:41)

You begun your career as a hepatologist and you were seeing people like Henry more towards the end stages of liver disease whereas now, would it be accurate to say from a research point of view, you're mostly focused on prevention, early detection, early treatment to reduce the number of people that end up in those end stages?

Aleksander Krag (2:05)

Yeah, that's perfectly correct. It's very interesting as a doctor to have very sick people trying to do something for them. But the truth is really when they're very advanced, the only thing that really matters is the liver transplant.

That's why I redirected my focus and say, okay, we need to prevent these people to get to this stage.

Actually, we already, just with baffled behaviors and now with breakthroughs and different types of drugs, are trying to help all this effort. How do we find these people at the right time, at the right place in the health care system? How do we give them the right advice, etc.? That is, I think, the whole transition where we basically move towards early detection, towards prevention, and both what we call primary prevention, starting from all the way from happening. If you already have something, liver disease of different severity, what can you actually do to prevent it actually from becoming a clinical problem?

Simon Hill (2:59)

I was reading the Lancet seminar that you wrote, and I think this will surprise people in there. You wrote that around 30 percent of the global population have steatotic liver disease and that's something we'll define in a moment here. But is a lot of that 30 percent or what amount of that 30 percent of people that have steatotic liver disease is undetected? Could there be someone listening right now who has this and has no idea?

Aleksander Krag (3:26)

Unfortunately, yes. The thing is that this overlaps very much with type 2 diabetes, it overlaps very much with obesity.

The sad thing, I don't know, give it or take but is that liver disease until very advanced stages is asymptomatic.

The issue is as many of these people, they have no idea. Then what happened is exactly what I explained there with Henry. Then at a certain point, they have this sign of advanced stage disease. Suddenly, they have what we call ascites accumulation, a fluid in the stomach that eases up or they're general not feeling well, losing weight or they have this vomiting blood or infection of the brain, some of these things where it's very advanced. That's why we also in the clinical guidelines suggested people with some of these risk factors like type 2 diabetes or severe obesity or continuously elevated liver function test, they should actually be assessed for liver disease. In particular now because we know a lot about it. So we can both do a lot and I'm sure we'll come back to that both with the behavioral changes which is really the backbone and how we also have the first two drugs that has proven effective and approved by the FDA and EMA also, which is really a breakthrough because that has been a search for 20 years to see, okay, can we really do something to revert or prevent this disease from progressing?